Seth Crumpton

Safety Essay
October 4, 2017 1

The Medical Dosimetrists Role in Safety

Medical dosimetrists play a pivotal role in the world of radiation oncology. This pivotal
role comes with an abundance of responsibilities that can vary to a considerable degree between
treatment centers. Medical dosimetrists are expected to play a role in treatment planning, physics
analysis, quality assurance, patient billing and patient documentation. But, none of these
responsibilities are as important as being an advocate of patient safety. Ultimately, dosimetrists
are expected to use their expertise to provide optimal treatment plans that contest the effects of a
cancer diagnosis while limiting unnecessary dose to the healthy tissue of the patient. This can be
far more difficult than it sounds because technology and techniques used to achieve these goals
are always changing. This means the role of the dosimetrist needs to evolve by integrating safety
into their daily practice.

In its purest form, radiation oncology can be considered a team effort. Each member has
a specific role to play that serves a greater purpose in the grand scheme of things. Medical
dosimetrists are a part of that team and the primary objective is to treat a patient in the safest
manner possible. To do this, it is imperative that the clinic creates a culture of safety by working
together to form a safe and efficient clinical environment.1 This can be achieved by
communicating well and discussing ways to correct mistakes that have been made. With that in
mind, it is important that oncology team members feel they can report mistakes or near misses
without fear of being reprimanded.2 Errors will happen, its simply human nature. But, being
familiar with the harmful effects of radiation can make working in radiation oncology very
stressful. One little mistake could result in an error that is detrimental to the patients health even
to the point of death in some cases. Even if the mistake is minor, employees will often make a
mountain out of a mole hill and assume the worst by assuming that mistake could cost them their
job. This fear could prevent an employee from reporting the details of that incident to the clinic.
This means the radiation oncology team does not have the opportunity to discuss the incident in
detail and come up with a solution to prevent it from occurring again in the future. Recognizing
the importance of this information and the barriers of communication that might ensue when an
incident has occurred, ASTRO and AAPM implemented the Radiation Oncology Incident
Learning System (RO-ILS).2 RO-ILS provides staff the means to report errors or near-misses
Seth Crumpton
Safety Essay
October 4, 2017 2

without the risk of punitive action being taken out of them.2 The data provided by the RO-ILS
can be used by facilities to implement procedures that limit the opportunities for these incidents
to occur. The outcomes of implementing this act based on this information could prove very
valuable to patient safety overall. As a member of the oncology team, a medical dosimetrist can
perform their role by being and advocate of this incident learning system and encouraging the
participation of the other team members on a daily basis.

One of the more important aspects in regards to safety that is checked on a daily basis is
quality assurance. Quality assurance is described as activities that are necessary to verify that a
product will satisfy the requirements of quality set forth by specific task groups.3 QAs are
performed on a daily, monthly and yearly basis. The QA procedures test everything from the
parameters of the linear accelerator to the parameters of the treatment planning system itself. The
bulk of QAs are typically performed by the medical physicist. However, dosimetrists do
participate in the assessment of planning directive, the approval of volumes, treatment
prescription accuracy, treatment plan quality and the final checks.1 It is important to note that
dosimetrists are not limited to this list of QA procedures. Depending on the site policy, patient
load, man power and other things of that nature, dosimetrists may be required to participate in a
more active role to ensure QA procedures are performed routinely enough to meet requirements.
Therefore, if a medical dosimetrist was looking for a way to integrate safety into their daily
practice, the dosimetrist could take on a more active role in QA analysis.

In conclusion, the role of the dosimetrist is not limited to generating optimal treatment
plans. In this paper I discussed two ways out of many for a dosimetrist to implement safety into
their daily practice through communication and quality assurance. The scope of radiation
oncology is always changing. As the field continues to change through technique and technology
the role of the dosimetrist will need to evolve. The dosimetrist can achieve this by relying on
their expertise in regards to the clinical relevance of radiation oncology to perform their various
duties as a functioning member of the radiation oncology team dedicated to application of
treatment in the safest environment possible.
Seth Crumpton
Safety Essay
October 4, 2017 3

References

1. ASTRO. Safety is no accident. A framework for quality radiation oncology care.

https://www.astro.org/uploadedFiles/Main_Site_/Clinical_Practice/Patient_Safety/Blue_
Book/SafetyisnoAccident.pdf. Accessed October 3, 2017.
2. ASTRO. RO-ILS. Radiation oncology incident learning system.
https://www.astro.org/RO-ILS.aspx. Accessed October 3, 2017.
3. Lenards N. Quality Assurance/Quality Management. [SoftChalk], La Crosse, WI. UW-L
Medical Dosimetry Program 2017.